- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.42 / $1,546.84 / $7,700.08
| Professional | | $1,486.42 | $1,546.84 | $7,700.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,681.20 / $1,750.07 / $2,210.00
| Professional | | $1,681.20 | $1,750.07 | $2,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.77 / $1,953.86 / $4,539.16
| Professional | | $1,427.77 | $1,953.86 | $4,539.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.81 / $1,992.09 / $3,197.01
| Professional | | $1,497.81 | $1,992.09 | $3,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.27 / $1,781.92 / $2,942.45
| Professional | | $1,258.27 | $1,781.92 | $2,942.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.58 / $1,722.48 / $2,142.75
| Professional | | $1,168.58 | $1,722.48 | $2,142.75 |